medical professionalism 10 20
TRANSCRIPT
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The Evolving Role of Healthcare Professionals
Matthew Katz, MD
October 20, 2011
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Disclosures• Doctor at Radiation Oncology Associates, PA
- Practice in MA, NH
• Volunteer for - American Society of Radiation Oncology- Massachusetts Medical Society- Mayo Clinic Center for Social Media
•Financial disclosures: none- No speakership, consulting, ownership stakes
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Overview
• Definition
• Challenge of social media
• Current guidelines
• Redefining professionalism
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What is a professional?
• Professional:– “conforming to the technical or ethical standards
of a profession”– “participating for gain or livelihood in an activity
or field of endeavor often engaged in by amateurs”
Merriam-Webster.com, accessed 9/19/11
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Social Media are Communication Tools
• Global reach
• Easy access
• Little technical expertise needed to use
• Immediate impact
• Dynamic content
Wikipedia, http://bit.ly/mZcwaH
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Social Media
• Presents perplexing challenge
• Transforming the way we interact
• Patients online for healthcare beyond the exam room
• Unclear how best to get involved without harm
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What data do we have on medical professionalism online?
• Survey of U.S. medical school deans– 60% of respondents confirmed medical students posted
unprofessional online content• Profanity/discriminatory ~50%• Sexually suggestive/intoxication ~40%
– Only 38% had social media policy in place
• Study of U Florida medical students/residents– 44% had Facebook account– 83% posted personal information, 70% had photos with
alcoholChretien et al, JAMA 2009Thompson et al, J Gen Intern Med 2008
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What about medical blogs?
Lagu et al, J Gen Intern Med 2008
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Risks of Social Media• Reputation– Expertise– Patient satisfaction
• Career– Medicolegal
• Patient harm– Privacy violation– Damage to doctor-patient relationship
• Boundaries• Blurring of personal and professional spheres
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Medicolegal Risks
• Disclosure of patient information– Statutory risk– Common law risk
• “Friending” patients– Established– Non-established
• Surfing social media sites of established patients• Physician as employer: social media risks• Malpractice & risk management
Terry Wall, ASTRO Annual Meeting 2011
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Benefits of Social Media• Collaboration
– Conducting research– Clinical guidelines– Donations for cancer care
• Connect with patients, others– Marketing your practice or organization– Enhance therapeutic relationship– Share your research
• Education– Patients– Colleagues, CME
• Reputation Management
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Yahoo!News, 9/18/2011
“Gamers produced an accurate model of the enzyme in just three weeks”
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AMA Guidelines• Patient privacy and confidentiality must be maintained in all
environments, including online
• Monitor own Internet presence to ensure personal and professional information is accurate and appropriate
• Maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines
• Confront medical colleagues that post unprofessional content
• Actions online and content posted may negatively affect their reputations among patients and colleagues and can undermine public trust in the medical profession
Adopted 11/2010
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Posted 6/20/2011
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Why Risk Getting Involved?
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We are public figures
• UK survey of 953 respondents in general public• Professionalism based upon
– clinician– workmanship– citizen
• Respondents expected doctors to be: – confident– reliable– composed– accountable– dedicated
Chandratilake et al, Clin Med 2010
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Oath of Maimonides
“May the love for my art actuate me at all times…
Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of
man can extend indefinitely to enrich itself daily with new requirements. “
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Social media can extend our domain
• Doctors are healers and teachers
• Opportunity to learn
• Lead by example
• Re-embrace millennia tradition of caring
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We are not on Medicine 2.0
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Evolution of Healers
v. Era Example Divine Healer/Wounded Dyad
Knowledge Scientific Method
1.0 Prehistoric Shaman + +
2.0 400 B.C. Galen + + +
3.0 18th-19th c. Virchow + + +
4.0 20th c. Osler + +
In 2011, v4.0 is a century old
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Medicine in 19th century
1846 Ether for anesthesia for H&N surgery
1858 Virchow’s Cellular Pathology
1859 Darwin’s On the Origin of Species
1860s Claude Bernard Experimental medicine
1870s Pasteur Germ theory, anthrax vaccine
1895 Roentgen’s discovery of x-ray
1899 Aspirin
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Flexner Report (1911)• Medical school education– 4 years– Merged into university– Standardized quality
• Implications for professionalism– Scientific method and knowledge trump caring– Higher cost of training limits access to upper class– Decreased access to poor, rural, people of color– Marginalized other approaches
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M.D. = Master Dilettante• Talented at absorbing salient information
• Integrating practical information and applying it
• Free from need for ‘complete’ knowledge– Able to take diverse data, synthesize it
• Focus on education,care for patient and caregivers– Values – Understanding = listening to each other
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Evolution of Professionals
Professional Origin ExampleDoctor 5th cent. BC HippocratesNurse 1850s Crimean WarEpidemiologist/Public Health
1840s London trash
Physical therapist 1813 Swedish GymnasticsParamedic 1860 American Civil WarDietician 18th-19th c.Social worker 1915 FlexnerMedical researcher 19th c. Claude BernardHospital administrator 1906 AHA
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Social media:with influence comes responsibility
Person/Entity Rationale
Advertisers/Marketers Split test = randomized trial
Mobile health app developers Influence health decisions
Social Networks Ecosphere for interactions
Patient advocacy groups Organizational advocates
Peers Peers = trusted source of information
Patients (all of us) Ultimate judge of quality but biased by experience
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Ethos of Medical Professionalism
• Traditional– Autonomy– Beneficence– Justice
• New
– Integrity– Connectedness
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Integrity & Connectedness• Integrity
Being ‘whole’ Honesty Transparency of intent Willingness to change
• Connectedness Centered on relationships Links professionalism to how we interact De-emphasizes knowledge, expertise Repudiates notion of pure objectivity
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Medicine 5.0
v. Era Example Divine Healer/Wounded Dyad
Knowledge Scientific Method
1.0 Prehistoric Shaman + +
2.0 400 B.C. Galen + + +
3.0 18th-19th c. Virchow + + +
4.0 20th Osler + +
5.0 21st ? + + +
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Health 5.0 ?
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Health 5.0
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